How to recognize fetal alcohol syndrome?

When the fetus has been harmed by the mother's alcohol consumption, it may look like FAS.

We have always heard that drinking during pregnancy is harmful to the baby, but little has been said about the possible consequences. Nowadays fetal alcohol syndrome is a phenomenon that, fortunately, is becoming more visible for greater and earlier detection by professionals, and so that families can feel better cared for and guided in the upbringing of their children with this condition.

What is FAS?

The so-called fetal alcohol syndrome, also known as FAS, was identified in 1973 by Kenneth Lyons Jones and David W. Smith. These investigators found a common pattern of facial and limb features, cardiovascular defects associated with prenatal growth deficiencies and developmental delays (Jones et al. 1973, p. 12). (Jones et al 1973, p. 1267).

Among the common features found, although not always as we will see below, there is a characteristic appearance: short height, low weight, small head, poor coordination, low IQ, behavioral problems and deafness or visual impairment. The face of these children has a somewhat greater separation between the eyes than that of other children, and perhaps as the most characteristic feature, the nasolabial fold is smooth.

How to identify fetal alcohol syndrome?

The reasons why parents seek consultation for fetal alcohol syndrome are mainly the following:

• Learning problems and difficulty in school.
• Speech and language delays.
• Hyperactive behavior.
• Attention and memory difficulties.
• Difficulty in impulse control, transgression of rules due to difficulty in learning the consequences.
• Feeling of not listening, it seems that they always have to be told the same thing and they continue to ignore it.

Can a baby always suffer from FAS when drinking alcohol?

Not all, but some of the chronic alcoholic women can have children born with the so-called Fetal Alcohol Syndrome (FAS), the highest degree of affectation in the spectrum of Alcohol Spectrum Disorders (ASD). It is a pathology present at birth that consists of a set of malformations in the development of the cerebral cortex.. It may appear on brain scans as a normal brain image, as they are sometimes subtle.

Because of their difficulty in learning due to damage to the systems involved in the correct functioning of memory, these children have difficulty learning and therefore, they may engage in disruptive or illegal behaviors that lead them to commit crimes, not because of excessive aggressiveness, but because of a lack of distinction between right and wrong, engaging in inappropriate behaviors and with the danger of being highly influenced by others.

These children also show a statistical tendency to engage in risky sexual activities, and are more vulnerable to drug addiction.

It is common for them to have difficulties in school, get into trouble with the police and even spend time in boarding schools or juvenile detention centers, and may end up in jail and families in debt to pay bail or penalties.

Types of PAS

Currently we can distinguish 4 classifications within the FASF.

1. PAS

This category includes cases with or without a confirmed history of fetal alcohol exposure..

2. Partial FAS

Occurs with or without a confirmed history of fetal alcohol exposure.

4. Alcohol-related birth defects (ARBD).

Presence of physical anomalies and other alcohol-related organic malformations that require confirmation of prenatal alcohol exposure. require confirmation of prenatal alcohol exposure (by maternal statement or by (by maternal statement or by laboratory analysis).

5. Alcohol-related neurodevelopmental disorder (ARND).

No physical abnormalities or growth retardation present. Requires confirmation of prenatal alcohol exposure (by maternal statement or by laboratory analysis).

Difficulty in diagnosis

Many of the children who present with FAS are adopted childrenespecially according to recent data from Russia and Ukraine. However, for parents who are not adoptive parents, there is a stigma and at the same time a certain prejudice on the part of the professional who must ask the obligatory question about alcohol consumption during pregnancy, even speaking of a classist syndrome typical of parents from a disadvantaged or marginalized social level.

In recent years, adoption associations and public organizations have begun to provide information and training on the possibility that adopted children may present FAS, especially if they come from high-risk countries such as those mentioned above, psychological preparation of the adoptive parents, so that they can be aware of the possibility of this and that they may know that this possibility exists.

Most of the parents come to our office after a long journey and several diagnoses. Recently things are improving since, in Barcelona, the Vall d'Hebron and the Hospital Joan de Déu are doing a great research work where they have units of professionals specialized in the diagnosis and research of FAS.

The common definition would be a difficult child, who has difficulty concentrating and maintaining attention, often diagnosed with Attention Deficit Disorder with or without hyperactivityADHD. However, the child who presents adhd usually has more preserved habits of care, in the day to day, greater social skills and present more problems of sustained attention, while in FASD there are more problems of divided attention.

We can also find children who have been diagnosed with ASDAutism Spectrum Disorder (ASD). However, unlike ASD, children with FAS do not present echolalia, stereotypies, there is social desire and they clearly express a wide range of emotions, although it is true that they find it difficult to regulate them, especially in intensity, and they have difficulties in issues related to theory of mind. Described by the psychologist and anthropologist Gregory Bateson, theory of mind is defined as the "capacity to reflect on and understand one's own and others' sensations" normally acquired between the age of 3 and 4 years (Pozo J.I, 1998).

And once we have the diagnosis?

The common guidelines for families that have demonstrated greater efficacy in the behavior of their children are the following.

• Consistency, with stable patterns, clear routines, concise and if possibleConcise and, if possible, with visual support.
• Written rules, with visual support and with equally treated consequences, immediate to the action that we want to reduce or increase.
• Repeat, repeat and repeat. It is important to remember that they have serious learning problems due to memory impairment.
• Affection and affection shows.

Author: Raquel Montero León. Child and adolescent psychologist at ARA Psicología..

Bibliographical references:

• Alonso Esteban, Y. and Alcantud Marín, F. (2011). Fetal Alcohol Syndrome and Fetal Alcohol Spectrum Disorders: Level of knowledge and attitudes of social-health professionals. III Cycle Program: Research in Psychology.
• Evrard, G. (2008). Brain developmental alterations in maternal-fetal alcoholism: role of the serotonergic system and astroglia. In: https://www.researchgate.net/publication/265965043_Alteraciones_del_desarrollo_cerebral_en_el_alcoholismo_materno-fetal_rol_del_sistema_serotoninergico_y_de_la_astroglia.
• Landgraf M.N., Nothacker M., Heinen F. (2017). Diagnosis of fetal alcohol syndrome (FAS): German guideline version 2013. Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilians, University of Munich, Lindwurmstrasse 4, 80337 Munich, Germany.
• Montoya Salas, K. (Sep. 2011). Síndrome alcohólico fetal. Med. leg. Costa Rica. vol.28 n.2 Heredia. Recuperado de http://www.fundacionmencia.org/noticias/sindrome-alcoholico-fetal/.
• Pozo Municio, J. I. (1999) Aprendices y maestros. Madrid: Alianza Editorial.
• Svetlana Popova, PhD Shannon Lange, MPH Charlotte Probst, MSc Gerrit Gmel, MSc Prof Jürgen Rehm. (2017). Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis. Volume 5, ISSUE 3, Pe290-e299. PhD Open AccessPublished: DOI: https://doi.org/10.1016/S2214-109X (17)30021-9.